Home health is a large and. Specialty Spotlight: Home Health. Did You Know?

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1 2015 ISSUE 2 Specialty Spotlight: Home Health Did You Know? At Summit, we spend $3 million to $4 million annually on home health services for our patients. Home health is a large and growing sector of the medical profession with more than 1.2 million workers nationwide, according to the Bureau of Labor and Statistics. It s also a significant factor in many workers comp injuries. At Summit, we spend $3 million to $4 million annually on home health services for our patients. And it s no wonder. In many cases, home health care is more comfortable and convenient than traditional hospitalization and can be just as effective in appropriate situations. The question providers must ask in a workers comp scenario, then, is this: When is home health care most advisable from an evidence-based medicine standpoint? As you know, we turn to the Official Disability Guidelines (ODG) for evidence. For most situations, including injuries of the head, neck, back, shoulder, hand, knee and leg, ODG offers a fairly basic guideline on home health services, in line with those from Medicare: Home Health Services are recommended only for otherwise recommended medical treatment for patients who are homebound, on a part-time or intermittent basis. Medical treatment does not include homemaker services like shopping, cleaning, and laundry, and personal care given by home health aides like bathing, dressing, and using the bathroom when this is the only care needed. These recommendations are consistent with Medicare Guidelines (CMS, 2004). For hip and pelvis injuries, ODG recommends home support after joint replacement surgery: Early discharge after hip arthroplasty with home support resulted in readmission rates less than 1 percent and high patient satisfaction. (Thomas, 2008) After discharge from postacute care for joint replacement, the vast majority of patients received home rehabilitation, outpatient rehabilitation, or both, with no setting effects related to rehospitalization or medical complications (DeJong, 2009). Continued on page 2 [ 1 ]

2 Continued from page 1 ODG has the most to say about home health for patients suffering from chronic pain: Recommended on a short-term basis following major surgical procedures or in-patient hospitalization, to prevent hospitalization, or to provide longer-term in-home medical care and domestic care services for those whose condition is such that they would otherwise require inpatient care. Home health services include both medical and non-medical services deemed to be medically necessary for patients who are confined to the home (homebound). Summit contracts with several ancillary provider networks, including home health. To find an ancillary provider, visit our website and click on Provider Resources, then Find an Ancillary Provider. ODG offers a handy list of criteria for determining whether a patient is a good candidate for home health services. Take a look: Justification for medical necessity of home health services requires documentation of: ❶ The medical condition that necessitates home health services, including objective deficits in function and the specific activities precluded by such deficits; ❷ The expected kinds of services that will be required, with an estimate of the duration and frequency of such services; and ❸ The level of expertise and/or professional qualification or licensure required to provide the services. Homebound is defined as confined to the home. To be homebound means: a. The individual has trouble leaving the home without help (e.g., using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) because of the occupational illness or injury OR b. Leaving the home isn t recommended because of the occupational illness or injury AND c. The individual is normally unable to leave home, and leaving home is a major effort (CMS, 2014). ❹ Evaluation of the medical necessity of home health care services is made on a case-by-case basis. For home health care extending beyond a period of 60 days, the physician s treatment plan should include referral for an in-home evaluation by a home health care agency registered nurse, physical therapist, occupational therapist, or other qualified professional certified by the Centers for Medicare and Medicaid in the assessment of activities of daily living to assess the appropriate scope, extent, and level of care for home health care services (CMS, 2015). ❺ The treating physician should periodically conduct reassessments of the medical necessity of home health care services at intervals matched to the individual patient condition and needs, for example, 30, 60, 90, or 120 days. Such reassessments may include repeat evaluations in the home. [ 2 ]

3 Working With Workers Comp Tampa Tank Wins with Clinic Relationships a policy of open and ongoing communication with their medical providers. EHS Director Troy Everhardt, periodically meets with the company s designated medical providers to be sure that they understand Tampa Tank s injury management goals. It s a basic but specific list of needs that Tampa Tank hopes to have met by the providers they work with. This Tampa Tank employee suits up in a full complement of safety gear before operating shop machinery. Tampa Tank, a Florida-based company, builds steel-welded tanks and pipelines for worldwide clients in industries such as petroleum, chemical and power. They also provide structural steel for commercial buildings and bridges. It s a dangerous industry, no doubt. Despite the hazards they face, Tampa Tank has set itself apart as a company that values safety and returning injured employees to work. CEO David Hale and his team believe that their focus on safety and injury management are a vital part of their long-running success. We truly do value the safety of our employees and the successful recovery of those who are injured. I won t even call safety a priority because it s not something we rank. It s like honesty. You don t rank it you just expect it. Together, three men Environmental Health and Safety (EHS) Directors Don Lowe and Troy Everhardt, along with Hale make up the company s unofficial safety and injury management triumvirate. For the past decade, they ve made it their business to continuously improve the safety culture and the return-to-work experience for Tampa Tank employees. Today, the company s story is one of continual improvement and ongoing success. They have one of the best safety records in their industry, and their return-to-work program stands out as a model for others to emulate. Clinic relationships Interestingly, one of the major strategies used by this innovative team revolves around the relationships they have with the medical clinics they partner with for patient care. Tampa Tank has We need doctors to understand that we re trying to manage the situation and provide the best possible care while still controlling costs, says Everhardt. We will accommodate a doctor s work restrictions in any way to get the employee back on the job. Tampa Tank s safety success list ❶ First, Everhardt describes the kinds of work that Tampa Tank employees do and the worstcase injury scenarios. Tampa Tank needs medical providers who can handle both the injury treatment and return-to-work process for those potential situations, and this conversation helps prepare providers for the injuries they may see. [ 3 ]

4 Billing Tips: ICD 10 Code Set Deadline The mandatory compliance date for converting to the ICD-10 code set is October 1, All services provided on or after the compliance date must be coded using the ICD-10 code set. Any bills submitted for services on or after the compliance date that do not include the ICD-10 code may be returned for resubmission of corrected codes. From left to right: Don Lowe Environmental Health and Safety Director (Field); David Hale President and CEO, Tampa Tank and Florida Structural Steel; Troy Everhardt Environmental Health and Safety Director (Shops) Any bills submitted with dates of service prior to October 1, 2015, can be submitted with the ICD-9 code set. However, those services must be billed separately from those submitted after October 1, ❷ Next, he makes it clear that Tampa Tank values patient care. A great cooperative starting point for their providers to know is that all parties are ultimately working toward the same goal: an excellent patient experience and the most efficient recovery process possible. ❸ Third, he outlines the company s return-to-work policy. We need doctors to understand that we re trying to manage the situation and provide the best possible care while still controlling costs, says Everhardt. We will accommodate a doctor s work restrictions in any way to get the employee back on the job. ❹ Finally, Everhardt asks about the physician s narcotic prescribing practices and, on this one, Tampa Tank takes a hard line. A provider who offers narcotics too soon, too often or for an inappropriately prolonged timeframe won t work with Tampa Tank for long. It s an interesting list, to be sure, and one that has clearly served Tampa Tank and their employees well. Currently, the company has an experience mod of 0.66, reflecting a 34 percent better safety and claims history than the average business in their industry category. Employers can help, too Are there employers in your area that you serve often or that you would like to work with more regularly? Don t wait for the employer to open the lines of communication. These could be great discussion points for you to initiate. Talk with employers about what injuries their employees may face. Discuss your patient care goals and narcotics policies. Let them share their strategies for return to work. With some preemptive communication, you may find that workers comp cases run more smoothly through your office and that your workers comp patients have a better overall recovery experience. Please visit for more information. Mark your Calendars September is Healthy Aging Month With Americans working longer than ever, the realities of an aging workforce are gaining the attention of employers across the country. Older workers are more prone to certain injuries and they tend to heal and return to work more slowly than their younger counterparts. To deal with this trend, many employers are encouraging fitness and healthy living among older (and all) workers. To find out more about how you can share this information with your patients, visit healthy-lifestyle/september-is-healthyaging-month/. [ 4 ]

5 MDspeak Narcotics and Patient Protection By Summit Medical Director, Karen Olson, MD MSPH Without a doubt, you ve heard this message before. Most media outlets that target medical providers have urged caution in prescribing opioids for more years than we can count. Nothing new, right? Well, don t tune out just yet. At Summit, we re committed to not only heralding the dangers of opioid prescription abuse, but also to providing you with tools to manage them safely. One of the ways we hope to help you do this is by giving you a quarterly snapshot of any patients with a concerning daily morphine equivalent dose (MED). Dangers of multiple narcotic prescriptions Because injured workers sometimes see a number of physicians over the course of a claim, it may not be obvious when these patients already have existing narcotic prescriptions. Many patients simply don t Reminder: A daily MED of 120mg is considered an addictive dose for patients who are already habituated to some level of narcotic medication. For a patient who has not become habituated to narcotics, a daily MED of 120mg is considered potentially lethal. understand the risks involved in taking multiple prescriptions and fail to mention it. In a small number of cases, patients take advantage of their physicians to feed an already established drug habit. Helping you prescribe accurately That s why at Summit, we review all of the injured workers in our system who have narcotic prescriptions each quarter and identify those with a daily MED exceeding 120mg. Every prescribing physician for an identified claim receives from us a notification outlining the total MED a patient is receiving. Since initiating this procedure in 2012, we ve received positive feedback from our physicians and have seen a dramatically reduced number of potentially dangerous prescriptions for patients in this category. Cases that are flagged by this procedure are Want to check a patient s MED yourself? Visit Summit s website to download an opioid dosage calculator for your own use. Download the calculator as a Microsoft Excel spreadsheet and enter the dosage of a prescribed narcotic. The calculator will then convert the data you entered into a morphine equivalent dose (MED). This allows you to compare one opioid medication against another and to find a total MED for all of the known medications prescribed to a patient. To access the opioid dosage calculator, click on Provider Resources and then Opioid Dosage Calculator. Source: This calculator was provided by Express Scripts, our pharmacy benefits manager, who obtained it from the State of Washington Department of Health. Heritage Summit HealthCare LLC disclaims any liability resulting from use of this tool. reevaluated 90 days after the physician notification is sent by our pharmacy benefit manager, Express Scripts. This provides us with a great snapshot of how effective our MED evaluation is. On average, these cases see a reduction of five to six prescription drugs during the 90-day period. That s huge! And, it means that you, our physicians, are using this tool to catch superfluous prescriptions and streamline patient medications. Lowering MED levels starts with you Please pay close attention to notifications listing a patient s MED level. Take the opportunity to review their prescriptions and, if needed, communicate with any other prescribing physicians. As always, feel free to give us a call for any additional information you may need. [ 5 ]

6 Drug Details In this section, you will find news and updates on prescription drugs, reprinted from Clinical Matters, a publication of our pharmacy benefits manager, Express Scripts. We hope this information is informative and helpful to you and your patients. Please note that any listing of medication in this column does not indicate payment approval for Summit s workers comp patients. All prescription drug approval must follow standard procedures. Abuse-resistant form of Zohydro ER is approved A new formulation for all strengths of the single-agent, extended-release hydrocodone product, Zohydro ER was FDA approved on January 30, A Schedule II controlled substance, Zohydro ER is indicated to treat severe chronic pain that needs continuous treatment and that has not been relieved by previous therapy options. The new form incorporates a proprietary technology called BeadTek that creates thick, sticky goo if the capsules are opened or crushed and the contents dissolved in liquids or solvents. First FDA approved in October 2013, original Zohydro ER, which has no abuse deterrents, will be phased out and replaced with the new form. Express Scripts is reviewing the data around the new Zohydro ER formulation for inclusion in the Express Scripts Long Acting Opioid Step Therapy Program. Update: After Express Scripts released this information, Zohydro ER underwent a change of ownership. The original manufacturer, Zogenix, sold Zohydro ER to Pernix Theraputics in March of this year. As of the original Express Scripts article, the FDA had not yet approved product labeling that specifies abuse resistance. For more information on Zohydro ER, visit the company s website at Click on Products, Branded Products, then Zohydro ER. (Reprinted with permission from Express Scripts, Clinical Matters newsletter.) Who Is Summit? With more than 35 years of experience, Summit is a leading provider of workers compensation insurance products and services to employers throughout the Southeast. Summit includes Summit Consulting LLC and its subsidiary, Heritage Summit HealthCare LLC. Summit is also the managing general agent of Bridgefield Casualty Insurance Company, Bridgefield Employers Insurance Company, BusinessFirst Insurance Company, Retailers Casualty Insurance Company and RetailFirst Insurance Company. For a full listing of the workers compensation payor customers who lease and have access to the Heritage Summit HealthCare LLC preferred provider network, visit the Provider Resources section of our website and click on State-specific payors. How to Contact Us Heritage Summit HealthCare PO Box 3623 Lakeland, FL Summit Claims Center PO Box 2928 Lakeland, FL hour injury reporting The information presented in this publication is intended to provide guidance and is not intended as a legal interpretation of any federal, state or local laws, rules or regulations applicable to your business. Heritage Summit HealthCare LLC has used its best efforts to select information for this publication from reliable sources, but cannot warrant that it is complete or accurate. Heritage does not assume and hereby disclaims any liability to any person for loss or damages caused by error or omission. Please check with your attorney for details about the laws as they may affect your specific business situation. Heritage Summit HealthCare LLC, 2310 Commerce Point Drive, Lakeland, FL Heritage Summit HealthCare LLC 8/15 (15-096) [ 6 ]